Uncertainty looms with Obamacare

With Obamacare inching slowly toward reality, the country’s medical profession is staring at an uncertain future as to how health care will be delivered to millions of Americans.
Hospitals like Thomasville Medical Center will be spending the next year getting ready for Jan. 1, 2014, the day when the Patient Protection and Affordable Care Act, the federal health care plan commonly known as Obamacare, comes into effect. Issues such as “who will run the program” and “will it make a difference in the number of uninsured people walking into emergency rooms” remain real question marks.
“There is so much we don’t know, still,” said Marci Wilding, director of government relations at Novant Health, the company that owns TMC. “We find ourselves in a place of very little clarity. [Open enrollment] begins in October, and right now, we really don’t know what it looks like. This is such a shift in the way we deliver health care.”
Under the new law signed in 2010, Americans will be required to have some form of health insurance, whether it’s private, through an employer or the government via Medicare or Medicaid. People may elect to enroll in the Health Benefit Exchange, but beginning in 2014, those who remain uninsured will face a penalty.
“Some people would use the word taxed,” Wilding said. “It will be on your taxes. If you do not have proof of health insurance you will be fined.”
Obamacare’s primary goal is to increase access to health care for millions of uninsured Americans. Wilding said hospitals already have started paying for the program through government cuts with the hope that as more people gain insurance, costly emergency room visits will decrease. A major fear is millions of people still elect to go uncovered.
“When health care reform was passed, hospitals and other providers took very, very drastic cuts to our Medicare payments as a way of paying for health care reform,” said Wilding. “We took the cuts with the idea that on the back end more people would be covered and we would therefore have less charity care and less people coming to our facilities who were not insured. Our concerns are there still will be a large segment of the population that is not insured. We’ll sort of get that double whammy.”
TMC has taken a proactive approach to the incoming health care reform law with programs designed to work in conjunction with Obamacare. Jane Wilder, TMC’s community relations director, said her hospital still will offer charity care, annual free health screenings and free monthly health classes because that’s what it always has done, but new programs are in place to better serve citizens.
“We have some initiatives in place that we’re already doing that complement some of the things that may be coming down the road,” Wilder said. “There are a lot of variables to it. It’s kind of hard to plan for something you really don’t know a whole lot about.
“We want people to have a pulse on what’s going on with their health. Our primary concern is to take care of the people of the community, regardless of the outcome.”
TMC at Home is a free preventive care program designed to limit the number of cases where patients leave the hospital with chronic disease such as diabetes and congestive heart failure only to return. A nurse assists patients with lifestyle changes once they leave the hospital, making sure proper prescriptions are being taken and helping manage their disease. Wilder credits the program for TMC experiencing a reduction in the number of patients readmitted to the hospital.
“We’re trying to work with patients once they leave the hospitals and go home to eliminate being readmitted. We know that can be a very cost prohibitive thing to come right back to the hospital if things aren’t going well. These are issues that would be ongoing, where people would need to make lifestyle changes. We‘re seeing that it‘s making a difference.”
As more people become insured, the demand for specialists is expected to increase. TMC recently hired an oncology coordinator to act as a liaison for cancer patients. Wilding’s concern is whether or not medical facilities can keep up with the increased demand for specialized care.
“Is there going to be somebody there to see?” Wilding said. “We’re obviously concerned that we aren’t going to have enough physicians because there aren’t enough physicians in the pipeline. As people age and live longer, I think it’s something we need to be aware of and making sure we’re keeping those pipelines full.
“When you have so many people who hopefully are insured, it seems to me that it would be harder to get that sort of care. We’re doing everything we can to recruit specialists to our facilities and hospitals like TMC because we want to make sure the community is served in that way. That’s a large concern in the health care community.”
Wilding said the health care system is flawed and Obamacare will address certain key issues that lead to unneeded ER visits and expensive charges for citizens.
“We do not want people to not have health insurance and let something go because they can’t afford to go to the doctor and end up in our emergency room,” said Wilding. “It’s an expensive way to deliver health care. It’s not only expensive, it’s a poor way to deliver health care – getting somebody when they’re very, very sick as opposed to seeing them earlier when you can do something less expensive and less evasive. In that sense, that’s something we want to do. It’s a business model that doesn’t necessarily work and we keep patching it. That’s the challenge.
“Every time we take care of someone with government insurance, whether it be Medicare or Medicaid, we’re losing money.”
Obamacare will be administered by each state, but Wilding said many states are reluctant to take on the responsibility.
"It's a very unique period of time," Wilding said. "We can talk about it but we're not going to know what it looks like until Jan. 1, 2014."

Staff Writer Eliot Duke can be reached at 888-3578, or duke@tvilletimes.com.